Fri Apr 19 2024

82 articles - From Friday Apr 12 2024 to Friday Apr 19 2024

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Gastroenterology

AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary.

This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors. Formal ratings regarding the quality of evidence or strength of the presented considerations were not included because systematic reviews were not performed.

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Gastrointest Endosc

American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity.

The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥ 30 kg/m 2 , or with a BMI of 27.0-29.9 kg/m 2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.

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Consensus statements on the current landscape of artificial intelligence applications in endoscopy, addressing roadblocks, and advancing artificial intelligence in gastroenterology.

The consensus process led by the ASGE AI Task Force and experts from various disciplines has shed light on the potential of AI in endoscopy and gastroenterology. AI-based algorithms have shown promise in augmenting endoscopist performance, redefining quality metrics, optimizing workflows, and aiding in predictive modeling and diagnosis. However, challenges remain in evaluating AI algorithms, ensuring transparency and interpretability, addressing governance and data procurement, determining payment models, defining relevant clinical outcomes, and fostering collaboration between stakeholders. Addressing these challenges while maintaining a balanced perspective is crucial for the meaningful advancement of AI in gastroenterology.

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Gut

British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults.

The clinical and scientific data underpinning the recommendations we make are summarised in detail. Much of the content will have broad relevance, but the treatment algorithms are based on therapies that are available in the UK and have regulatory approval for use in the National Health Service.

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The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines.

The guidelines also considered emergent literature on the use of FMT in non-CDI settings (including both gastrointestinal and non-gastrointestinal indications), reviewing relevant randomised controlled trials. Recommendations are provided regarding special areas (including compassionate FMT use), and considerations regarding the evolving landscape of FMT and microbiome therapeutics.

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Meta-analysis

meta-analyses and systematic reviews

Am J Gastroenterol

Quantified Metrics of Gastric Emptying Delay by GLP-1 Agonists: A Systematic Review and Meta-Analysis with Insights for Periprocedural Management.

While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (AAT), particularly at time points relevant to periprocedural care.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Application of clinical decision support tools for predicting outcomes with vedolizumab therapy in patients with inflammatory bowel disease: A KASID multicentre study.

CDSTs for VDZ had acceptable accuracy in predicting effectiveness outcomes including clinical and biochemical outcomes in UC. However, their utility in CD was limited.

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Crohn's disease after surgery: Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study.

Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.

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Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database.

Most colonoscopies were performed on patients with low-risk symptoms, where cancer risk was similar to the general population. Cancer and large polyp yield was highest in elderly patients with rectal bleeding or anaemia, although still fell short of FIT-based screening yields.

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Prospective evaluation of patients with non-cirrhotic portal hypertension: A single centre study.

Patients irrespective of specific features of PH had similar survival or survival without decompensation. Patients without specific features are at risk for disease progression and should be monitored closely. Thrombocytopenia and increased LSM are associated with severe forms of liver disease, which are strongly associated with outcomes.

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Am J Gastroenterol

Adjunctive Use of WATS-3D in Symptomatic GERD Patients Increases Detection of Barrett's Esophagus and Dysplasia.

The addition of WATS-3D to FB in GERD patients being screened for BE resulted in confirmation of BE in an additional ⅕th of patients. Furthermore, dysplasia diagnoses approximately doubled.

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Association of endoscopist colonoscopy quality measures with follow-up colonoscopy outcomes after positive stool tests (mt-sDNA or FIT): Retrospective cross-sectional analysis of data from the New Hampshire Colonoscopy Registry.

The frequency of negative colonoscopies after positive stool tests was significantly higher in exams performed by endoscopists with low ADR and CSSDR. Our results also suggest a benchmark target of at least 40% for ADR in patients with mt-sDNA+ or FIT+ tests, and 20% for SSLs in mt-sDNA+ patients.

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Effects of clip anchoring on preventing migration of fully covered self-expandable metal stent in patients undergoing ERCP: a multicenter, randomized controlled study.

Our data suggest that clip-assisted anchoring is an effective and safe method for preventing migration of FCSEMS without increasing the adverse events.

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Focal distal esophageal dilation (blown-out myotomy) after achalasia treatment: prevalence and associated symptoms.

30% of the patients treated with POEM develop a BOM, which is associated with a higher acid exposure, more reflux symptoms and symptoms of regurgitation.

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The public's intended uptake of hypothetical esophageal adenocarcinoma screening scenarios: a nationwide survey.

Participants in this study self-selected through a web-based survey, potentially introducing selection bias. Participants generally intended to participate in EAC screening, although the level of intent depends on the discomfort and performance associated with the offered screening test. Determining eligibility based on GERD symptoms, age, or a risk calculator, but not sex, would be acceptable to most individuals.

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Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting.

As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. Here, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.

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Visceral adipose tissue reduction measured by deep neural network architecture improved reflux esophagitis endoscopic grade.

Visceral obesity is strongly associated with RE. VAT volume reduction was prospectively associated with improvement in RE endoscopic grade dose-dependently. Visceral obesity is a potential target for RE treatment.

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Clin Gastroenterol Hepatol

Differential effects of genetic polymorphism on comorbid disease in metabolic dysfunction-associated steatotic liver disease.

This combination of MASLD-related genetic variants is useful for predicting LRE in Japanese patients with MASLD. The genetic risk according to these variants is useful for LRE risk assessment, especially in patients without metabolic risk factors or in younger patients in Japan.

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Factors affecting nonfunctioning small pancreatic neuroendocrine neoplasms and proposed new treatment strategies.

NF-spNENs are heterogeneous with varying levels of malignancy. Therefore, treatment strategies based on tumor size alone can be unreliable; personalized treatment strategies that consider tumor grading are preferable.

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One Year Outcomes Among Children Identified With Celiac Disease Through A Mass Screening Program.

This novel study of children with CD identified through a mass screening program demonstrated improvement in symptoms, quality of life, and iron deficiency after one year follow up. This demonstrates that there may be benefit to CD mass screening.

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Endosc Int Open

A safe and effective endoscopic treatment method for simple hepatic cysts (with video).

ETGHCD provided a feasible, safe, effective, and minimal invasive alternative approach for the treatment of simple hepatic cysts.

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Development of a novel endoscopic hemostasis-assisted navigation AI system in the standardization of post-ESD coagulation.

The effectiveness and safety of this endoscopic treatment-assisted AI system that identifies visible vessels requiring PEC should be confirmed in future studies.

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Impact of a new dedicated sheath device for tissue sampling of biliary stricture on pathological diagnostic yield: Retrospective study.

TBFB with the novel sheath device contributed to improved sensitivity for diagnosis of biliary stricture without insertion of forceps outside the bile duct.

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Long-term course of untreated asymptomatic esophageal eosinophilia and minimally symptomatic eosinophilic esophagitis.

Instead, the localized type may spontaneously improve, implying a different pathogenesis in the presence of the diffuse type. Further studies should clarify the long-term prognosis.

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Low-dose pulsed vs standard pulsed fluoroscopy during ERCP to reduce radiation without change in image quality: Prospective randomized study.

Low-dose pulsed fluoroscopy is a reliable method that substantially reduces radiation without compromising image quality or affecting procedure or fluoroscopy times. This underscores the need for standardization in ERCP fluoroscopy settings to limit radiation exposure.

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Primary anastomosis closure after endoscopic ultrasound-directed transgastric intervention.

Single-stage EDGI is an effective approach to managing RYGB patients with pancreaticobiliary pathology. Thus far, endoscopic TTS tack-based suturing appears to have a high success rate in anastomosis closure after LAMS removal and should be considered as a primary method for preventing chronic fistulae.

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Endoscopy

Impact of long-term transmural plastic stents on recurrence after endoscopic treatment of walled-off pancreatic necrosis.

Among patients who undergo ETD of WON, leaving DPS in situ seems to lower the risk on recurrent fluid collections, without any long term DPS-related complications. These results suggest that DPS should not be routinely removed and can be safely left indwelling indefinitely.

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Safety and efficacy of salvage endoscopic submucosal dissection for Barrett's neoplasia recurrence after radiofrequency ablation.

In expert hands, salvage ESD is a safe and effective treatment for recurrence of Barrett's neoplasia after RFA treatment.

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Gastroenterology

Clinical presentation and spectrum of gluten symptomatology in celiac disease.

Biomarkers like interleukin-2 that are highly sensitive and specific for celiac disease highlight a role for gluten-specific T cells in acute gluten symptomatology. A mechanistic understanding of symptoms will inform approaches to better measure and effectively treat them.

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How future pharmacological therapies for celiac disease will complement the gluten-free diet.

An increasing spectrum of therapeutic approaches target defined mechanisms in celiac disease pathogenesis, and some currently advance to phase 2-3 clinical studies. We discuss these approaches in terms of potential efficiency, practicability, safety and need as defined by patients, regulatory authorities, health care providers and payors.

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Phosphatidylinositol 4-kinase III alpha governs cytoskeletal organization for invasiveness of liver cancer cells.

PI4KIIIα regulates cytoskeleton organization via PIK3C2γ/Akt2/paxillin-cofilin to favor migration and invasion of liver cancer cells. These findings provide mechanistic insight into the contribution of PI4KIIIα and HCV to progression of liver cancer and identify promising targets for therapeutic intervention.

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Gastrointest Endosc

COMPUTER-AIDED DIAGNOSIS IMPROVES CHARACTERIZATION OF BARRETT'S NEOPLASIA BY GENERAL ENDOSCOPISTS.

CADx assistance significantly increased characterization performance of BE neoplasia by general endoscopists to the level of expert endoscopists. The use of this CADx system may thereby improve daily Barrett surveillance.

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Detection of residual stones by peroral direct cholangioscopy in patients with intrahepatic stones after hepaticojejunostomy: A prospective study (with video).

PDCS is a safe and effective procedure for complete stone removal in patients with IHBD stones after HJ.

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The use of a real-time computer-aided detection system for visible lesions in the Barrett's esophagus during live endoscopic procedures, a pilot study.

In this pilot study, the CADe system detected al potentially neoplastic lesions in Barrett's esophagus comparable to an expert endoscopist. Continued refinement of the system may improve specificity. External validation in larger multicenter studies is planned.

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Validation of Artificial Intelligence-based Bowel Preparation Assessment in Screening Colonoscopy.

In unqualified-AI patients, the >5mm AMR was significantly higher than in qualified-AI patients (35.71% vs 13.19%, p=0.0056, OR 0.2734, 95% CI 0.1139, 0.6565), as were the AMR (50.89% vs 20.79%, p 5mm AMR, provided key evidence for implementing AI in guiding the bowel re-cleansing, potentially standardizing the future colonoscopy screening; ClincialTrials. gov, NCT05145712.

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Gut

Clinical, experimental and pathophysiological effects of Yaq-001: a non-absorbab le, gut-restricted adsorbent in models and patients with cirrhosis.

This study provides strong preclinical rationale and safety in patients with cirrhosis to allow clinical translation.

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Porcine-derived pancreatic enzyme replacement therapy may be linked to chronic hepatitis E virus infection in cystic fibrosis lung transplant recipients.

PwCF had disproportionate rates of HEV seropositivity, regardless of transplant status. Chronic HEV infection was evident only in CF transplant recipients. HEV may represent a significant risk for pwCF, particularly post-transplant. Studies to assess HEV incidence and prevalence in pwCF, and potential role of PERT are required.

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Recurrent RhoGAP gene fusion CLDN18-ARHGAP26 promotes RHOA activation and focal adhesion kinase and YAP-TEAD signalling in diffuse gastric cancer.

Design We built a transgenic mouse model with fusion is a gain-of-function DGC oncogene that leads to activation of RHOA and activation of FAK and YAP signalling. These results argue for further evaluation of emerging FAK and YAP-TEAD inhibitors for these deadly cancers.

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Hepatology

Acute hepatic porphyrias - a guide for Hepatologists.

The AHPs are very treatable conditions, with excellent outcomes if diagnosed and treated early. A high index of suspicion for the presence of these disorders along with accurate testing and timely treatment will help reduce the burden of disease and prevent irreversible complications in patients with AHP.

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Alcohol-associated liver cancer.

In the current review, we discuss the pathogenesis, heterogeneity, preclinical approaches, epigenetic and genetic profiles of A-HCC, and discuss the current insights into and the prospects for future research on A-HCC. The potential effect of alcohol on cholangiocarcinoma and liver metastasis are also discussed.

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Alcohol-associated liver disease - global epidemiology.

Addressing the growing ALD concern requires robust public health initiatives, heightened awareness, refined diagnostic techniques, and comprehensive epidemiological studies. These measures are vital to tackle the increasing prevalence of ALD and mitigate its extensive impact on individuals and healthcare systems.

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An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study.

Harnessing AI within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at

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Comparing serial and current liver stiffness measurements to predict decompensation in compensated advanced chronic liver disease patients.

Once the current LSM is known, previous LSM values do not add to the prediction of LREs in cACLD patients.

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ER stress signaling at the interphase between MASH and hepatocellular carcinoma.

Here we propose that chronic ER stress is a common transversal factor contributing to the transition from liver disease (risk factor) to HCC. Interventional strategies to target the UPR in HCC as cancer therapy are also discussed.

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Machine learning-based plasma metabolomic profiles for predicting long-term complications of cirrhosis.

We developed a metabolomic state-integrated nomogram, which enables risk stratification and personalized administration of liver-related events.

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Neutralizing antibodies to interferon alfa arising during peginterferon therapy of chronic hepatitis B in children and adults: Results from the HBRN trials.

The development of anti-IFNα nAbs during PegIFNα treatment diminishes responses to antiviral therapy. Understanding how and why anti-IFNα antibodies develop may allow for optimization of IFN-based therapy, which is critical given its renewed use in HBV-cure strategies.

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Non-invasive tests for alcohol-associated liver disease.

Additionally, the evaluation of NITs for screening and predicting ALD and liver complications was addressed comprehensively. Future perspectives of NITs for ALD were explored, alongside a thorough discussion of the opportunities and challenges associated with NITs for ALD screening.

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J Hepatol

B cell characteristics define HCV reinfection outcome.

MBC quality, but not necessarily breadth of nAb responses, is important for protection against antigenically diverse variants, which is encouraging for HCV vaccine development.

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Comparison of non-contrast abbreviated MRI and ultrasound as surveillance modalities for HCC.

Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. Impact and implications Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma (HCC) in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and surveillance intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast (NC)-abbreviated MRI (AMRI) exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in high-risk patients for HCC. Adopting alternating US and NC-AMRI at 6-month intervals demonstrated significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. Clinical trial number ClinicalTrials.gov Identifier NCT02551250.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Clin Gastroenterol Hepatol

Phenotypes of MASLD-associated hepatocellular carcinoma.

Its natural history, prognosis and treatment are specifically addressed, as the role of metabolic phenotypes of MASLD-HCC as a potential strategy for risk stratification. The challenges in identifying high-risk patients and screening strategies are also discussed, as well as the potential approaches for MASLD-HCC prevention and treatment.

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Gastroenterology

Intestinal inflammation and extraintestinal disease: understanding dynamic risk.

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Presentation of the Julius M. Friedenwald Medal to M. Bishr Omary.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

Antibiotic Prophylaxis for ERCP.

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Individualizing the Approach to Stopping Nucleos(t)ide Analogs: Can We Use a Low HBsAg Threshold to Predict a High Chance of Functional Cure and Minimal Risk of Hepatic Decompensation?

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Underwater Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors.

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Clin Gastroenterol Hepatol

Artificial Intelligence and Medical Liability in Gastrointestinal Endoscopy.

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The Role of Advanced Practice Providers in Modern Gastroenterology Practice.

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Endosc Int Open

A novel "NOTES" technique for treating incarcerated stones in the gallbladder neck.

Pubmed   Journal   ReadQx   PMC

Water pressure method for endoscopic submucosal dissection of a rectal tumor on the gravitational side close to the dentate line.

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Endoscopy

A single common target across the world: to make colorectal endoscopic submucosal dissection safer, faster, and easier for R0 resection.

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An elastic traction device for facilitating endoscopic submucosal dissection of a submucosal tumor at the cardia.

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Internal and external bidirectional traction facilitating endoscopic submucosal excavation of a huge subepithelial tumor in the fornix of the gastric fundus near the cardia.

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The running suture with clip and string technique after colonic endoscopic submucosal dissection.

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Gastroenterology

An Unusual Cause of Cat Scratch Colon.

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Clearance of gut mucosal SARS-CoV-2 antigens and post-acute COVID-19 after two years in patients with inflammatory bowel disease.

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Microbial metabolite: a link between psychological stress and epithelial disturbance.

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Unlocking the potential of fecal virome transplants (FVT): modulating the gut-brain axis in stress-related disorders.

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Gut

Mast cells and histamine in cholangiocarcinoma: exploring overlooked avenues for enhanced patient management.

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Hepatology

"Reply: Chronic hepatitis B baseline viral load and on-treatment liver cancer risk: A multinational cohort study of HBeAg-Positive patients".

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Clonal hematopoiesis of indeterminate potential and risk of hepatocellular carcinoma: New kids on the block.

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Hepatology Highlights.

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Innovations in Healthcare Delivery for Patients with Cirrhosis.

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Letter to the Editor: Chronic hepatitis B baseline viral load and on-treatment liver cancer risk: A multinational cohort study of HBeAg-Positive patients.

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Letter to the Editor: Endoscopy for potential variceal bleeding within 12 hours- not so fast!

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Letter to the Editor: On the use of non-selective beta blockers in cirrhosis.

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Reply: Endoscopy for potential variceal bleeding within 12 hours-not so fast!

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Reply: On the use of non-selective beta blockers in cirrhosis.

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J Hepatol

A different picture on liver biopsy.

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From the Editor's Desk...

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Letters&Replies

Letters to the editors and authors’ replies

Clin Gastroenterol Hepatol

Complexity of trials on pain management in acute pancreatitis: an ongoing challenge.

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Gastroenterology

GLP1 receptor agonists and post-endoscopic aspiration pneumonia: what plays a role in clinical practice?

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Gut

EUS-guided gallbladder drainage in acute cholecystitis: response to letter to the editor.

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